A common issue in Medicare billing for pain management is confusion between diagnostic and therapeutic facet joint injections, which are intended to follow a structured, stepwise process.

• Diagnostic injections, such as medial branch blocks, are performed to confirm the facet joint as the source of pain, requiring clear documentation of measurable pain relief (a defined percentage) to support progression to further treatment like radiofrequency ablation.
• A second diagnostic facet procedure is considered medically necessary to confirm validity of the initial diagnostic facet procedure when administered at the same level. The second diagnostic procedure may only be performed for a minimum of two weeks after the initial diagnostic procedure.
• These procedures are not meant for long-term relief, yet providers sometimes document or bill them as therapeutic services without demonstrating diagnostic intent or response.

From a Medicare standpoint, this distinction is essential, as coverage depends on proper sequencing, medical necessity, and documented outcomes; failure to clearly differentiate the purpose of each injection is a frequent source of denials and audit findings, as each encounter must align with LCD requirements and demonstrate its role in the patient’s overall treatment plan.